Provider Demographics
NPI:1558461087
Name:NAYOWITH, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:NAYOWITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LEWIS AVE
Mailing Address - Street 2:FAIRVIEW HOSPITAL EMERGENCY DEPT
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1713
Mailing Address - Country:US
Mailing Address - Phone:413-854-9638
Mailing Address - Fax:413-854-9639
Practice Address - Street 1:29 LEWIS AVE
Practice Address - Street 2:FAIRVIEW HOSPITAL EMERGENCY DEPT
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1713
Practice Address - Country:US
Practice Address - Phone:413-854-9638
Practice Address - Fax:413-854-9639
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210687207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E44705Medicare UPIN
MAA33123Medicare ID - Type Unspecified